Document Type : Original Article
1. Introduction and Objective
With the rapid growth of the elderly population, type 2 diabetes mellitus is recognized as one of the most common age-related chronic diseases. The primary pathogenesis involves low-grade chronic inflammation, which induces insulin resistance and accelerates disease progression through continuous secretion of pro-inflammatory cytokines, particularly interleukin-1 (IL-1). Interleukin-1 receptor antagonist (IL-1ra) is produced endogenously and inhibits inflammatory pathways by competitively binding to the IL-1 receptor (IL-1R). Calprotectin (S100A8/S100A9 heterodimer), as a marker of neutrophilic inflammation, is also directly associated with obesity, insulin resistance, and type 2 diabetes. Conversely, glutathione peroxidase (GPX), as a key antioxidant enzyme, plays a crucial role in neutralizing hydrogen peroxide and lipid peroxides. Regular aerobic exercise and the consumption of bioactive compounds found in grains—especially wheat enriched with flavonoids, polyphenols, and selenium—are recognized as effective non-pharmacological strategies for reducing inflammation and oxidative stress. The organic herbal supplement NBS (Nutrition Bio-Shield) Superfood, which is primarily produced from grains and wheat, has demonstrated anti-inflammatory and antioxidant effects in previous studies. The aim of the present study was to investigate the effect of eight weeks of moderate-intensity aerobic training combined with NBS Superfood supplementation on serum levels of calprotectin, IL-1ra, and glutathione peroxidase in elderly men with type 2 diabetes.
2. Materials and Methods
This semi-experimental study with a pretest–posttest design and a control group was conducted on 40 elderly men aged 60 to 75 years with type 2 diabetes residing in Kermanshah. Participants were selected via purposeful sampling and were randomly assigned into four groups of 10 using stratified randomized block design based on age and diabetes duration: control group (CONT), training group (TR), supplement group (SUP), and training + supplement group (TR+SUP). Inclusion criteria included medical confirmation of type 2 diabetes, absence of active diabetic ulcers, no history of amputation or non-diabetic neurological/orthopedic diseases, and absence of inflammatory arthropathies or advanced retinopathy. Exercises were performed on a stationary bicycle (Powermax, model K29100). To determine individual intensity, an incremental workload test was initially performed: participants pedaled for 3 minutes without load, followed by a 3-minute warm-up at a constant load of 60 W, and subsequent workload increases of 40 W every 3 minutes until voluntary exhaustion to determine the maximum tolerable workload.
). Main training sessions were conducted at an intensity of 60% to 70% for 30 minutes, three sessions per week for eight consecutive weeks. A certified trainer supervised all sessions, and adherence to the designated duration, intensity, and number of sessions was strictly monitored. Participants in the supplement-receiving groups (SUP and TR+SUP) consumed 10 grams of NBS Superfood supplement daily prior to one of their main meals for eight consecutive weeks. Blood samples were collected in two phases (baseline and 48 hours after the last intervention session) following a 12-hour fast, and serum levels of calprotectin, IL-1ra, and GPX were measured using the ELISA method. Data were analyzed using the Shapiro–Wilk test, Levene's test, two-way repeated measures analysis of variance, and univariate analysis of covariance (controlling for baseline values) in SPSS software version 26. The significance level was set at 0.05.
3. Results
The Baseline characteristics (age, height, weight, BMI, body fat percentage, fasting glucose, insulin, HbA1c, and duration of diabetes) showed no significant differences among the groups. Analyses revealed that the main effect of group, the main effect of time, and the group × time interaction effect were significant for all three variables (
). Regarding calprotectin, a significant decrease was observed in the intervention groups, with the greatest reduction occurring in the training + supplement group (a decrease of 
). Serum IL-1ra levels also decreased significantly, with the lowest posttest level belonging to the combined group (a decrease of 
). Conversely, glutathione peroxidase activity increased significantly, with the highest increase reported in the training + supplement group (an increase of 
). Tukey's post-hoc tests confirmed significant differences between the control group and the intervention groups, particularly the combined group. These findings indicated a synergistic effect between aerobic exercise and NBS supplementation.
4. Conclusions
In Eight weeks of moderate-intensity aerobic training alone, and particularly in combination with NBS Superfood supplementation, led to a significant decrease in calprotectin and IL-1ra and a remarkable increase in glutathione peroxidase activity in elderly men with type 2 diabetes. The most pronounced changes were observed in the combined group, indicating a synergistic effect of both interventions. The reduction in calprotectin may be attributed to decreased neutrophil infiltration into adipose tissue and improvements in body composition. The decrease in IL-1ra is likely due to reduced IL-1$\beta$ production and a decreased need for a compensatory response. Furthermore, the increase in GPX can be explained by the activation of the Nrf2 pathway and the provision of essential micronutrients, particularly phenolic compounds and selenium present in the supplement. Combining regular moderate-intensity aerobic exercise with natural supplements rich in bioactive compounds can be proposed as a potential and promising combined strategy for reducing chronic inflammation and oxidative stress in elderly individuals with type 2 diabetes. However, definitive confirmation of the efficacy and safety of this approach requires future studies with larger sample sizes, longer intervention periods, and systematic evaluation of side effects.
Acknowledgment & Funding
Sincere gratitude is extended to all participants who contributed to the execution of this research with patience and cooperation. This study was funded personally by the authors and received no external financial support.
5. Ethical Considerations
This study was approved by the Ethics Committee of Islamic Azad University, Kermanshah Branch, in compliance with ethical standards under the ethics code IR.IAU.KSH.REC.1404.081.
6. Authors' Contributions
All authors contributed to the manuscript. All authors read and approved the final manuscript.
7. Conflict of Interest
The authors declare no conflict of interest.
